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A 62-year-old man presented with subacute, painless vision loss in the right eye that developed over the course of 1 week. He had a history of well-controlled type 2 diabetes and diffuse large B-cell lymphoma that was diagnosed 3 years earlier. The lymphoma was initially treated with chemotherapy, followed by a relapse that required additional chemotherapy and ultimately autologous bone marrow transplant 3 months before presentation. At the time of presentation, he was taking no immunosuppressive medications and was taking prophylactic acyclovir, 800 mg twice daily, and sulfamethoxazole/trimethoprim (800 mg/1600 mg) 3 times weekly.
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Chronic retinal necrosis due to cytomegalovirus
C. Administer intravitreal foscarnet and initiate valganciclovir
Based on the constellation of clinical findings, there was high clinical suspicion for cytomegalovirus (CMV) retinitis, so the patient was treated empirically with intravitreal foscarnet, 2.4 mg, and oral valganciclovir, 900 mg, twice daily. Aqueous tap and polymerase chain reaction analysis results returned 3.5 million copies of CMV DNA, confirming a diagnosis of chronic retinal necrosis (CRN) due to CMV.
Cytomegalovirus retinitis typically occurs in patients with severe immunosuppression and has been well described in patients with AIDS.1,2 Cytomegalovirus retinitis often lacks substantial intraocular inflammation and may manifest as either an indolent progressive peripheral granular necrotizing retinitis or as a fulminant posterior hemorrhagic retinitis.1,2
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Corresponding Author: Mark W. Johnson, MD, University of Michigan, Kellogg Eye Center, 1000 Wall St, Ann Arbor, MI 48105 (email@example.com).
Published Online: December 12, 2019. doi:10.1001/jamaophthalmol.2019.4915
Conflict of Interest Disclosures: Dr Wubben reported consulting fees from Allergan outside the submitted work. Dr Johnson reported serving on data safety monitoring boards for Pfizer and Syneos Health. No other disclosures were reported.
Additional Contributions: We thank the patient for granting permission to publish this information.
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